Dysphagia aortica

Contained Rupture of a Thoracic Aortic Aneurysm: A Rare and Life-Threatening Cause of Dysphagia

Dysphagia is commonly seen in the elderly and has both benign and malignant causes. A difficulty in swallowing due to the esophageal compression by the aorta, or dysphagia aortica, is a rare entity, little described in literature. However, diagnostic error or diagnostic and treatment delays of aortic dysphagia can be fatal. Herein, we report a case of dysphagia aortica caused by the contained rupture of a descending aneurysmatic thoracic aorta, presenting at the emergency department with acute dysphagia and diffuse chest pain, successfully treated by thoracic endovascular aneurysm repair.

Esophageal necrosis secondary to thoracic aortic aneurysm

We present the case of a 78-year-old man with dyslipidemia with ongoing treatment with statins. He was admitted for a history of 3-month dysphagia and weight loss. The physical exam was unremarkable. Blood tests revealed anemia (hemoglobin 11,5 g/dL). Gastroscopy showed a partially stenotic bulging ulcer in the middle esophagus, with a fibrinous base and residual clot Histopathology ruled out any malignancy and confirmed the presence of transmural necrosis with infiltration of inflammatory cells. Computed tomography (CT) revealed a 11x11x12 cm thoracic aortic aneurysm, with an intramural 4 cm thrombus in the anterolateral wall. The patient was referred for urgent Vascular Surgery, but unfortunately, he presented massive hematemesis with cardiorespiratory arrest, and despite cardiopulmonary resuscitation, he died.

Aortic aneurysm: An uncommon cause of dysphagia

Dysphagia is a serious symptom and requires urgent investigations and prompt diagnosis to initiate appropriate therapy. Dysphagia aortica is a rare entity described as difficulty in swallowing due to external compression by the aorta. The incidence of this entity is unknown. Herein we present a 90-year-old woman who presented with a progressive 3-month history of dysphagia, diagnosed with aortic aneurysm who then developed related complications and succumbed. Dysphagia aortica should be considered in the list of differential diagnoses in a patient with dysphagia although rare. Early diagnosis and management are vital to avoid poor outcomes.